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An assessment of the efficacy of antimicrobial prophylaxis in bone marrow autografts
J Z Wimperis1, T P Baglin, R E Marcus
1Department of Haematology, Addenbrooke's Hospital, Cambridge, UK.
Abstract:
Fifty-three patients undergoing autologous bone marrow transplantation received antimicrobial prophylaxis with ciprofloxacin with or without erythromycin and low dose intravenous amphotericin B. Eight patients remained afebrile throughout the neutropenic period. All other patients had one or more febrile episodes. The median time to fever after the onset of neutropenia was 7 days. There were no gram-negative organisms isolated from blood cultures during any of these episodes whereas gram-positive organisms were isolated in 28. There was one death in this series associated with sepsis. The use of low-dose prophylactic parenteral amphotericin did not prevent the subsequent successful use of full dose amphotericin for antibiotic-resistant fever. Ciprofloxacin effectively prevents gram-negative sepsis. The addition of erythromycin does little to prevent gram-positive sepsis. The use of regimens with agents with activity against gram-positive organisms is appropriate initial treatment of all febrile neutropenic episodes.
Insights
Ciprofloxacin effectively prevents gram-negative sepsis in bone marrow transplant patients. However, adding erythromycin offers little protection against gram-positive sepsis, necessitating broader antimicrobial coverage for febrile neutropenic episodes.
Area of Science:
- Hematology
- Infectious Diseases
- Pharmacology
Background:
- Autologous bone marrow transplantation (ABMT) patients are at high risk of infection due to profound neutropenia.
- Fever during neutropenia requires prompt and effective antimicrobial management.
- Gram-positive bacteria are a significant cause of sepsis in these immunocompromised patients.
Purpose of the Study:
- To evaluate the efficacy of antimicrobial prophylaxis with ciprofloxacin, with or without erythromycin, and low-dose intravenous amphotericin B in ABMT patients.
- To assess the spectrum of pathogens causing febrile episodes during neutropenia.
- To determine the role of prophylactic low-dose amphotericin B.
Main Methods:
- Prospective study of 53 patients undergoing ABMT.
- Antimicrobial prophylaxis included ciprofloxacin +/- erythromycin and low-dose intravenous amphotericin B.
- Monitoring for febrile episodes, blood cultures, and causative organisms.
Main Results:
- Eight patients (15%) remained afebrile; the rest experienced febrile episodes, with a median onset 7 days after neutropenia.
- No Gram-negative organisms were isolated from blood cultures; Gram-positive organisms were isolated in 28 episodes.
- Prophylactic low-dose amphotericin B did not preclude the need for full-dose therapy for resistant infections.
- Ciprofloxacin was effective against Gram-negative sepsis, but erythromycin provided minimal benefit against Gram-positive sepsis.
Conclusions:
- Ciprofloxacin is effective in preventing Gram-negative sepsis in ABMT patients.
- Erythromycin offers limited additional benefit in preventing Gram-positive sepsis.
- Regimens including agents with Gram-positive activity are crucial for initial management of febrile neutropenic episodes.